Kalter H D, Hossain M, Burnham G, Khan N Z, Saha S K, Ali M A, Black R E
Department of International Health, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205, USA.
Paediatr Perinat Epidemiol. 1999 Jan;13(1):99-113. doi: 10.1046/j.1365-3016.1999.00151.x.
The objective of this study was to validate retrospective caregiver interviews for diagnosing major causes of severe neonatal illness and death. A convenience sample of 149 infants aged < 28 days with one or more suspected diagnoses of interest (low birthweight/severe malnutrition, preterm birth, birth asphyxia, birth trauma, neonatal tetanus, pneumonia, meningitis, septicaemia, diarrhoea, congenital malformation or injury) was taken from patients admitted to two hospitals in Dhaka, Bangladesh. Study paediatricians performed a standardised history and physical examination and ordered laboratory and radiographic tests according to study criteria. With a median interval of 64.5 days after death or hospital discharge, caregivers of 118 (79%) infants were interviewed about their child's illness. Using reference diagnoses based on predefined clinical and laboratory criteria, the sensitivity and specificity of particular combinations of signs (algorithms) reported by the caregivers were ascertained. Sufficient numbers of children with five reference standard diagnoses were studied to validate caregiver reports. Algorithms with sensitivity and specificity > 80% were identified for neonatal tetanus, low birthweight/severe malnutrition and preterm delivery. Algorithms with specificities > 80% for birth asphyxia and pneumonia had sensitivities < 70%, or alternatively had high sensitivity with lower specificity. In settings with limited access to medical care, retrospective caregiver interviews provide a valid means of diagnosing several of the most common causes of severe neonatal illness and death.
本研究的目的是验证通过回顾性访谈照顾者来诊断新生儿重症疾病和死亡的主要原因。从孟加拉国达卡两家医院收治的患者中选取了149名年龄小于28天、有一项或多项可疑诊断（低出生体重/重度营养不良、早产、出生窒息、产伤、新生儿破伤风、肺炎、脑膜炎、败血症、腹泻、先天性畸形或损伤）的婴儿作为便利样本。研究儿科医生进行了标准化的病史采集和体格检查，并根据研究标准安排了实验室检查和影像学检查。在婴儿死亡或出院后，中位间隔64.5天时，对118名（79%）婴儿的照顾者进行了关于其孩子疾病的访谈。根据预先定义的临床和实验室标准得出参考诊断，确定照顾者报告的特定体征组合（算法）的敏感性和特异性。对有五种参考标准诊断的足够数量的儿童进行了研究，以验证照顾者的报告。确定了新生儿破伤风、低出生体重/重度营养不良和早产的敏感性和特异性>80%的算法。出生窒息和肺炎的特异性>80%的算法，其敏感性<70%，或者相反，敏感性高但特异性较低。在获得医疗服务有限的环境中，回顾性访谈照顾者为诊断几种最常见的新生儿重症疾病和死亡原因提供了一种有效的方法。
